经导管动脉化疗栓塞术中化疗药物剂量对肝癌患者T细胞亚群的影响

Effect of dosage of anticancer agents during transcatheter arterial chemoembolization on T cell subsets in patients with hepatocellular carcinoma

目的：探讨经志管动脉化疗栓塞术（TACE）中化疗药物剂量对肝癌患者肝细胞癌（HCC）患者T导胞亚群的影响。方法：36例不能动手术切除的HCC患者随机分成A、B两组，分别进行选择性TACE。A组（n=18)给予小剂量化疗药物：肿瘤直径小于5cm者给予丝裂霉素（MMC）2－4mg；在5-8cm之间者给予MMC4－6mg及表阿霉素（EPI）10mg；大于8cm者给予MMC6－8mg、EPI10mg及卡铂（CBP)100mg。B组（n=18)给予常规剂量化疗药物（MMC10mg、CBP300mg及EPI40mg）。术前和术后1周用流式细胞仪检测患者外周血T细胞亚群（包括CD ^3+、CD^4+、CD^8+、NK、CD^4+/CD^8+、CD^4+CD45^+、CD4^+CD29^+、CD8^+CD28^+、CD8^+CD38^-)。结果：治疗前两组间各细胞亚群均无显著差异；A组患者治疗后CD ^3+、CD^4+、CD^8+、NK、CD^4+/CD^8+、CD^4+CD45^+、CD4^+CD29^+、CD8^+CD28^－无显著变化。但CD4^+CD45^＋显著下降（P＜0．05），CD8^+CD28^+明显增高（P＜0．001）；B组CD4^+、CD4^+CD29^+和CD^4+/CD8^+比值显著下降（P＜0．05），CD8^+、CD8^+CD28^-显著增高（P＜0．05）。结论：常规剂量化疗药物TACE 可明显抑制细胞免疫功能，而小剂量化疗药物TACE可以提高患者细胞免疫功能。

Objective To investigate the effects of the dosage of anticancer agents during transcatheter arterial chemoembolization (TACE) on the T cell subsets in patients with hepatocellular carcinoma (HCC). Methods Thirty-six patients with unresectable HCC were randomly divided into 2 groups to receive superselective TACE. Patients in group A (n=18) received low-dose (2-4 mg) mitomycin C (MMC) as the anticancer drug when the tumor was less than 5 cm in diameter; when the tumor ranged from 5 and 8 cm in diameter, 4-6 mg MMC along with 10 mg epirubicin (EPI) was given, and in cases of even larger tumors, 6-8 mg MMC, 10 mg EPI and 100 mg CBP were prescribed. Conventional chemotherapy regimen constituted by 10 mg MMC, 40 mg PI and 300 mg CBP was adopted in group B (n=18). The peripheral blood T cell subsets including CD3 + , CD4 + , CD8 + , NK, CD4 + /CD8 + ratio, CD4 + CD45 + , CD4 + CD29 + , CD8 + CD28 + and CD8 + CD28 - were measured by flow cytometry in both groups before and one week after treatment. Results The T cell subsets were comparable in the 2 groups before the treatment. After TACE, no significant changes occurred in CD3 + , CD4 + , CD8 + , NK, CD4 + /CD8 + , CD4 + CD29 + or CD8 + CD28 - cells in group A, while significant decrease in CD4 + CD45 + and increase in CD8 + CD28 + cells were observed (P<0.05 and P<0.001, respectively). In group B, CD4 + and CD4 + CD29 + levels, together with CD4 + /CD8 + ratio, were significantly lower than those before treatment (P<0.05), but CD8 + and CD8 + CD28 - subsets were significantly higher (P<0.05). Conclusions The cellular immune function of HCC patients is significantly impaired by anticancer drugs for TACE at conventional dose, while low-dose of the drugs may enhance the cellular immune function.